physiotherapy after stroke Flashcards
physio after stroke – initial
Chest Physiotherapy
Early mobilisation
Link with OT regarding seating as required
Prevent Hemiplegic Shoulder Pain
Guide transfers and safety on the ward
Establish habits to promote care and activity of affected side
Educate family and nursing staff regarding the above
Consider outcome measures to use
- chest physio
- risk factors
- treatment
Risk Factors
Smoker
Immobile: in bed until seating assessment
Risk of respiratory infection
Swallow impairment: under SLT review NPO but trial of oral intake
Reduced level of consciousness on admission
Treatment
Optimised position in bed for respiratory status until seating assessment
Deep Breathing Exercises to prevent Atelectasis
Secretion clearance: prompting for coughing, assisted cough.
Active cycle of breathing technique
early mobilisation
positioning for people affected by stroke:
lying on affected
- uneffected leg forward on 1/2 pillows
- ensure hips are supported with pillows front and behind
lying on unaffected side
- affected shoulder forwards arm on pillow
affected leg forward on 1/2 pillow
hips are supported
lying on back
- affected arm on pillow
- pillow beneath affected hip
- feet in neutral to avoid excessive hip rotation
high sitting
- short periods only
sitting upright with support from pillows under each arm
support legs for comfort
- seating
Rea’ wheelchair or comfort chair
Tilt in space function
Pressure relieving cushion
Head rest
Foot plates with support
- prevent hemiplegic shoulder pain
Ask patient regarding any shoulder or arm pain
Establish habits to care for hand and promote activity in the arm
Provide positioning and seating plan in liaison with OT
Optimise Trunk Alignment
Consider use of lap tray, cuffs or slings as appropriate
Consider use of electrical stimulation
Assess and preserve ROM towards neutral / external rotation
outcome measures
Motor assessment scale
Postural Assessment scale for stroke
Fugel Meyer Assessment
Rehab complexity scale
health condition body functions activity participation contextual factors
Health Condition
Large MCA Territory stroke NIHSS = 22 classifying it as severe (previous medical history Hypertension, Atrial Fibrillation, Cardiac History, Smoker)
Body functions and structures (impairments)
Dense right sided weakness, aphasia, dysphagia and neglect leading to reduced active rom, reduced balance, reduced postural control reduced body awareness reduced endurance & difficulty with communication
Activity
Abilities – bed mobility able to roll from side to side with assistance of one, able to sit statically with minimal supervision Limitations- requires max assistance of two/three to stand with plinth support.
Participation
Abilities -Can sit out when family in for visiting and be wheeled down to the coffee shop in the hospital increasing his time sitting out
Limitations- unable to participate and sit out for periods longer than 30 mins, secondary to feeling low and requesting to go back to bed.
Contextual factors
Environmental/ Personal + self motivated when discussing therapy , internal stress about illness and limitations compared to previous function, cognitive impairment affecting processing and insight.
short term goals
. Achieve sliding board with assistance of one person in physiotherapy sessions to remove need for hoist in sessions
- Sit out in wheelchair for long enough to allow trips out with family members, trips to hospital shop to pick out his own newspaper, trips to coffee shop with visitors
setting goals for rehab
Ensure that goal-setting meetings during stroke rehabilitation:
are timetabled into the working week
involve the person with stroke and, where appropriate, their family or carer in the discussion
intensity of stroke
45 minutes of each relevant stroke rehabilitation therapy for a minimum of 5 days per week to people who have the ability to participate, and where functional goals can be achieved.
If more rehabilitation is needed at a later stage, tailor the intensity to the person's needs at that time.
set up
position
Position Transitions Variables Sit Perch Side sit Squat Stand Stride stance
Push Pull Stand up Lift off Sit to stand Reach to floor Reach overhead Walk Carry Stairs
Bed height Foot position Arm support Use of wall or plinth in front Gravity Eccentric/concentric/Isometric Closed chain/Modified Closed Chain/open chain Position of therapist Equipment Hoist / Sliding board/ETAC turner
handling
facilitation
inhibition
facilitate - encourage what I do want
through the environment sensory input
inhibition - stopping what I don’t want
use your voice strongly with cues
what are closed chain exercise
exercises performed where thefoot(for leg movement) orhand(for arm movement) and doesn’t move during the exercise. The foot/hand remains in constant contact with a surface, usually the ground.
These exercises are typically weight bearing exercises, where an exerciser uses their own body weight and/or external weight. Modified close chain are where the surface that the foot or hand is in contact with moves during the activity
Examples of Closed Kinetic Chain Exercises include:
Back Squats, Front Squats, Leg Press, Lunges
Push-ups, Handstand Push-ups andPull-ups.
equipment prescription
know person’s current activity status
know person’s main impairment
foot drop treatment
treadmill training dictum splint FES biomes ankle foot orthosis hand function = constraint induced mvmt therapy electrical stimulation bioness
